{"reporting_entity_name": "GQO_PPO","reporting_entity_type": "GQO_PPO","last_updated_on": "2026-10-07","version": "1.0.0","out_of_network":[{"name":"Emergency dept visit","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99284","description":"Emergency dept visit","allowed_amounts":[{"tin":{"type":"ein","value":"272134141"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":217.36,"providers":[{"billed_charge":1581.00,"npi":[1528319639]}]}]}]},{"name":"Manual Therapy Techniques 1 Or More Regions 15 Min. Each","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"97140GP","description":"Manual Therapy Techniques 1 Or More Regions 15 Min. Each","allowed_amounts":[{"tin":{"type":"ein","value":"251857035"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":50.05,"providers":[{"billed_charge":77.00,"npi":[1912967134]}]}]}]},{"name":"Office\/outpatient visit est","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99212","description":"Office\/outpatient visit est","allowed_amounts":[{"tin":{"type":"ein","value":"461322238"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":82.80,"providers":[{"billed_charge":150.00,"npi":[1952727778]}]}]}]},{"name":"Routine venipuncture","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36415","description":"Routine venipuncture","allowed_amounts":[{"tin":{"type":"ein","value":"133273402"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":3.75,"providers":[{"billed_charge":57.50,"npi":[1790362077]}]}]}]},{"name":"Specimen handling office-lab","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99000","description":"Specimen handling office-lab","allowed_amounts":[{"tin":{"type":"ein","value":"133273402"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":77.50,"npi":[1790362077]}]}]}]},{"name":"Therapeutic Exercises","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"97110GP","description":"Therapeutic Exercises","allowed_amounts":[{"tin":{"type":"ein","value":"251857035"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":53.95,"providers":[{"billed_charge":83.00,"npi":[1912967134]}]}]}]},{"name":"Ultrasound Therapy","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"97035GP","description":"Ultrasound Therapy","allowed_amounts":[{"tin":{"type":"ein","value":"251857035"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":26.00,"providers":[{"billed_charge":40.00,"npi":[1912967134]}]}]}]}]}
